Emerging competition in physician credentialing is highlighting long-standing concerns about the cost and time required to maintain board certification, Medscape reported May 6.
Here is what to know.
1. Physician board certification has typically involved one of 24 specialty boards under the American Board of Medical Specialties.
2. A 2025 analysis of ABMS data published in the American Journal of Medicine estimated that physicians spend more than $12 billion on maintenance of certification fees and related costs throughout their careers. The American Board of Internal Medicine certification maintenance fees are $220 for the first certificate and $120 for each additional one, and physicians who choose the 10-year exam pay a $700 test center fee.
3. In 2022, the National Board of Physicians and Surgeons — formally recognized by The Joint Commission — opened an alternative certification pathway. The board now represents more than 15,000 physicians and is accepted by about 250 hospitals, health systems and insurers nationwide. It offers both general and subspecialty certifications in dozens of fields.
4. The NBPAS’ appeals are its lower costs and alternative education requirements. It requires physicians to hold an active, unrestricted license; have completed certification through ABMS or American Osteopathic Association member board; and complete at least 50 hours of accredited continuing medical education every two years. The cost per certificate is $189 for a two-year cycle, according to Medscape.
5. Health systems ultimately decide through their bylaws and credentialing policies if they will accept an NBPAS certification in lieu of an ABMS member board. Some states also have rules restricting which physicians can advertise themselves as “board certified.” Due to these restrictions, some physicians choose to maintain certification through traditional boards in addition to the NBPAS.
6. The NBPAS has lobbied lawmakers to remove “entrenched monopolistic practices” in the ABMS certification process that hinder competition and limit physician autonomy, the report said. Physicians have also brought the matter before court. In 2018, physicians brought a class-action antitrust lawsuit against the ABIM, alleging it illegally tied initial certification to ongoing maintenance requirements and created a monopoly that prevented competition.
7. Other specialty groups are exploring alternative boards. Cardiologists have moved to establish their own certifying body — the American Board of Cardiovascular Medicine — but the ABMS declined the group’s 2025 application. The ABIM is the only certified body for cardiovascular medicine.
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